Should Psychoactive Drugs be given to Young Children?

Should younger children be given psychoactive drugs that have a host of side effects including the possibility of addiction?

Four year olds given drugs?

A report released at the 2011 American Academy of Pediatrics National Conference recommends that children as young as four can be diagnosed and treated for attention-deficit hyperactivity disorder (ADHD). Does this mean more pharmaceutical drugs for young children?

Likely, according to most health experts. However, according to the report, titled “ADHD: Clinical Practice Guidelines for the diagnosis, Evaluation and Treatment of Children and Adolescents with Attention-Deficit Hyperactivity Disorder,” non-drug behavioral intervention should be the fist preference of treatment, especially for pre-schoolers aged four and five years old.

Behavioral intervention includes a variety of techniques that encourages behavior management. Techniques include group dynamics – orchestrating controlled communications using groups, independent parent training to enable appropriate parenting responses, and other interactive training. Some simply call this “appropriate parenting.”

According to the guidelines, if children do not respond enough to this treatment, drug intervention should then be instituted.

Ritalin problems

The drug of choice for ADHD in children is methylphenidate – marketed under brands Ritalin, Concerta, Methylin and often referred to as MPH.

Methylphenidate works by increasing dopamine and noradrenaline in the brain. This effect has the same pharmacological effect as cocaine, though milder. Is it addictive like cocaine as well?

A study funded by the U.S. National Institute on Drug Abuse found that methylphenidate caused brain changes similar to those resulting from cocaine se. Dr. Nora Volkow, the director of the National Institute on Drug Abuse, commented in 2009 that studies on methylphenidate have showed it does not increase the risk of subsequent addiction, but added, “However non-medical use of methylphenidate and other stimulant medications, can lead to addiction as well as a variety of other health consequences.”

She commented further about the NIDA study that, “This study highlights the fact that we know very little about how methylphenidate affects the structure of and communication between brain cells.”

Methylphenidate is considered a psychostimulant, and a psychiatric drug.

Many parents are also concerned about methylphenidate’s side effects. And multiple studies have confirmed there are a number of serious side effects to consider with methylphenidate use by children. One study, published in the Journal of the Canadian Medical Association, analyzed 62 placebo-controlled, randomized clinical studies of 2,897 total children. The combined meta-analysis of these studied found that over 44% of parents and children reported side effects from methylphenidate, and 46% had side effects according to teachers. Teachers also reported that over 26% of the children had serious side effects of one kind or another among the methylphenidate children.

The most prevalent side effects included insomnia (over 47% of parents/children reported this, of which almost 11% were considered serious); decreased appetite (up to 46% as reported by teachers, of which 26% was considered serious); headaches (18% as reported by children and parents, of which 7% was considered serious), stomach aches (24% as reported by children and parents, of which 5% was considered serious); anxiety (31%); and dizziness (7%). Some of the children also reported side effects for the placebos, but when those were subtracted from the side effects reported for the medicated children there were still 30% more children reporting side effects, with nearly 9% considered serious.

Ritalin was considered unsafe under six years old

Previous to these 2011 guidelines released by the American Academy of Pediatrics, Methylphenidate (Ritalin, etc.) was considered unsafe for children under the age of six. With the new guidelines now recommending treatment for as young as four years old, most experts agree this will boost the sales of the drug.

A 2007 report projected 2008 methylphenidate sales at $3.4 billion per year, growing to over $4 billion per year by 2015. Most industry experts predict this growth will be even higher now that children as young as four will be treated with methylphenidate.

Dr. Volkow also expressed that the drug is still not well understood. “Further studies are needed to determine the behavioral implications of these changes and to understand the mechanisms by which these drugs affect synapse formation,” she said.

About 8% of all U.S. children between four and 17 have now been diagnosed with ADHD. We reported recent studies showing that ADHD is significantly associated to the western diet. Other research has found that social playing benefits ADHD children.

References

SUBCOMMITTEE ON ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, STEERING COMMITTEE ON QUALITY IMPROVEMENT AND MANAGEMENT. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2011 Oct 16.

Schachter HM, Pham B, King J, Langford S, Moher D. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. CMAJ. 2001 Nov 27;165(11):1475-88.

Volkow ND, Fowler JS, Wang G, Ding Y, Gatley SJ. Mechanism of action of methylphenidate: insights from PET imaging studies. J Attention Disorders 6(Suppl. 1):S31–S43, 2002.

Wilens TE, Faraone SV, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 111:179–185, 2003.

Mannuzza S, Klein RG, Truong NL, et al. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: prospective follow-up into adulthood. Am J Psychiatry 165(5):604–609, 2008.